Lic Reassignment Form Sample Filled -

| Field | Filled Value | |--------|----------------| | We, the Assignee, accept the above assignment and agree to be bound by its terms. | | | Signed by (Assignee) | R. N. Krishnamurthy | | Designation | Branch Manager – SBI, Pune | | Place | Pune | | Date | 18/01/2025 | | Witness 1 Name | Neeta Joshi | | Witness 1 Signature | (signed) | | Witness 2 Name | Amit Khanna | | Witness 2 Signature | (signed) | Section 7: Acknowledgment by Policyholder (Rajesh Sharma) Even though policyholder is not a party to assignment, LIC often requires their consent/acknowledgment.

☑ Complete assignment of all rights ☐ Partial assignment (not applicable here) lic reassignment form sample filled

Loan amount sanctioned: ₹8,00,000 (against policy surrender value) Section 5: Signature & Witness (Assignor – Existing Assignee) | Field | Filled Value | |--------|----------------| | Signed by (Assignor) | S. Mehta | | Designation | Authorised Officer – HDFC Bank | | Place | Mumbai | | Date | 15/01/2025 | | Witness 1 Name | Anjali Desai | | Witness 1 Address | Andheri East, Mumbai | | Witness 1 Signature | (signed) | | Witness 2 Name | Vikram Patil | | Witness 2 Address | Ghatkopar West, Mumbai | | Witness 2 Signature | (signed) | Section 6: Acceptance by Assignee (New Assignee – SBI) This section is critical – without acceptance, assignment is not complete. | Field | Filled Value | |--------|----------------| |

| Field | Filled Value | |--------|----------------| | Full Name | | | Address | HDFC Bank House, Senapati Bapat Marg, Lower Parel, Mumbai – 400013 | | Relationship to policyholder | Previous Mortgagee (Loan repaid in full) | | Policy currently assigned? | Yes – as per assignment dated 01/04/2019 | Section 3: Details of the Assignee (New owner of policy rights) The Assignee is the person/entity receiving the rights. Krishnamurthy | | Designation | Branch Manager –